Provider First Line Business Practice Location Address:
6000 NEW WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97601-9382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-884-1841
Provider Business Practice Location Address Fax Number:
907-729-4235
Provider Enumeration Date:
07/27/2007